Group B streptococcal septicemia of the newborn

Definition

Alternative Names

Group B strep; GBS

Causes, incidence, and risk factors

Septicemia is an infection in the bloodstream that may travel to different body organs. Group B streptococcal septicemia is caused by the bacterium Streptococcus agalactiae, which is commonly called "group B strep" or GBS. A newborn with septicemia is very sick.

GBS is commonly found in adults and older children, where it does not usually cause infection. There are two ways in which it may be passed to a newborn baby:

The infant can become infected as he or she passes through the birth canal. In this case, babies become ill between birth and 6 days of life (most often in the first 24 hours). This is called "early-onset" GBS disease.

The infant may also become infected after delivery by coming into contact with people who carry the GBS germ. In this case symptoms appear later, when the baby is 7 days to 3 months or more old. This is called "late-onset" GBS disease.

GBS now occurs less often, because now there are methods to screen and treat pregnant women at risk.

The following increase an infant's risk for group B streptococcal septicemia:

Being born more than 3 weeks before the due date (prematurity), especially if the mother goes into labor early (preterm labor)

Mother who has already given birth to a baby with GBS sepsis

Mother who has a fever (over 100.4 degrees F) during labor

Mother who has group B streptococcus in her gastrointestinal, reproductive, or urinary tract

Rupture of membranes ("water breaks") more than 18 hours before the baby is delivered

Use of intrauterine fetal monitoring ("scalp lead") during labor

Symptoms

Anxious or stressed appearance

Blue appearance (cyanosis)

Breathing difficulties such as:

Flaring of the nostrils

Grunting noises

Rapid breathing

Short periods without breathing

Irregular or abnormal heart rate - may be fast or very slow

Lethargy

Pale appearance (pallor) with cold skin

Poor feeding

Unstable body temperature (low or high)

Signs and tests

To diagnose GBS septicemia, GBS bacteria must be found in a sample of blood (blood culture) taken from a sick newborn.

Expectations (prognosis)

Complications

Disseminated intravascular coagulation (DIC) -- a serious disorder in which the proteins that control blood clotting are abnormally active

Hypoglycemia -- low blood sugar

Meningitis -- swelling (inflammation) of the membranes covering the brain and spinal cord caused by infection

Respiratory failure -- breathing stops

Calling your health care provider

This disease is usually diagnosed shortly after birth, often while the baby is still in the hospital.

However, if you have a newborn at home who shows symptoms of this condition, seek immediate emergency medical help or call the local emergency number (such as 911).

Parents should watch for symptoms in their baby's first 6 weeks. The early stages of this disease can produce symptoms that are hard to spot.

Prevention

To help reduce the risk of Group B streptococcal septicemia, the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and U.S. Centers for Disease Control and Prevention recommend that pregnant women get tested for group B streptococcus at 35 - 37 weeks into their pregnancy. If the bacteria are detected, women are given antibiotics through a vein during labor. If the mother goes into premature labor before 35 weeks, she should be tested for GBS.

Newborns who are at high risk are tested for GBS infection. They may receive antibiotics through a vein during the first 48 hours of life until blood culture results are available.

In all cases, proper hand washing by nursery caretakers, visitors, and parents can help prevent the spread of the bacteria after the infant is born.